Method and apparatus for securing soft tissue to bone

ABSTRACT

Apparatus for securing an object to bone, the apparatus comprising:
         a suture anchor assembly comprising a suture anchor body and a suture;
           the suture anchor body being configured to be lockingly disposed within a hole formed in the bone, and having an opening formed therein for slidably receiving the suture therethrough;   the suture having a first end, a second end and an intermediate portion extending therebetween;   the suture extending through the opening in the suture anchor body so that the intermediate portion forms a loop on one side of the opening and the first and second ends are disposed on the other side of the opening, such that when the first end of the suture is passed through the loop and securingly engages the object, pulling on the second end of the suture draws the loop and a captured portion of the suture along a path toward the opening in the suture anchor body;   the suture anchor body being configured so that when the suture anchor body is disposed in the hole in the bone, a tapered binding zone is established along the path followed by the loop and the captured portion of the suture when the second end of the suture is pulled, the tapered binding zone having a successively decreasing cross-sectional area such that continued pulling of the second end of the suture causes the loop and the captured portion of the suture to be jammed tightly in the tapered binding zone, whereby to bind the suture, and hence the object, to the suture anchor body, which is itself lockingly disposed within the bone.

FIELD OF THE INVENTION

This invention relates to surgical methods and apparatus in general, andmore particularly to surgical methods and apparatus for securing softtissue to bone.

BACKGROUND OF THE INVENTION

Various types of soft tissue are normally attached to bone. By way ofexample but not limitation, ligaments connect bone to bone, and tendonsconnect muscle to bone. By way of further example but not limitation,the labrum is soft tissue which is connected to the rim of theacetabular cup (i.e., bone) so as to form a natural seal for the hipjoint.

Such bone-connected soft tissues may become detached from their hostbone as the result of injury and/or disease. By way of example but notlimitation, a ligament or tendon or labrum may all be detached from bonedue to a sports-related injury. A detached ligament or tendon can causeanatomical instability, impede proper motion of the joint and causepain. A detached or damaged labrum can impede proper motion of the hipjoint and cause pain in the hip. In all of these cases, as well asnumerous others, the corrective treatment typically involves surgicallyre-attaching the soft tissue to bone.

In addition to the foregoing, in some cases it may be necessary tointentionally detach soft tissue from bone in order to provide atherapeutic treatment. In these situations it is generally necessary tothereafter re-attach the soft tissue to its host bone. By way of examplebut not limitation, where a patient suffers from a pincer-typefemoroacetabular impingement (FAI) of the hip joint, it may be necessaryto remove the overgrown portion of the acetabular rim in order toalleviate the pincer-type impingement. This generally involvessurgically detaching the labrum from the acetabulum, debriding theunderlying acetabular bone, and then re-attaching the labrum to theacetabulum.

Thus it will be seen that in many cases it may be necessary or desirableto attach (or re-attach) soft tissue to bone.

Historically, soft tissue has been attached (or re-attached) to boneusing nails, screws, staples and suture extended through holes formed inthe bone. All of these approaches suffered from a variety ofdeficiencies, including loosening, tissue necrosis, etc.

More recently, suture anchor assemblies have been used to secure softtissue to bone. More particularly, these suture anchor assembliesgenerally have two suture strands attached to a suture anchor body, thesuture anchor body is deployed in the bone, and then the suture strandsare used to tie the soft tissue to the bone. This is done by passing oneor more of the suture strands through the soft tissue, properlytensioning the suture, and then tying a knot (or knots) in the free endsof the suture so as to secure the soft tissue to the bone.

While such suture anchor assemblies have proven to be a major advanceover earlier attachment techniques, they suffer from the seriousdisadvantage of requiring the surgeon to tie a knot (or knots) in thesuture. More particularly, it can be time-consuming and technicallychallenging to form a tight knot in the suture, particularly duringarthroscopic procedures where the soft tissue attachment needs to takeplace at a remote location within the interior of a joint. Such remoteknot-tying is currently done by forming a suture throw outside thejoint, sliding the suture throw down to the surgical site using a suturerundown tool, forming a second suture throw outside the joint, slidingthat second suture throw down to the surgical site using the suturerundown tool, etc. until the knot is formed. It will be appreciatedthat, at best, this procedure is time-consuming and, at worst, resultsin a knot which may provide inadequate securement and/or impropertension to the soft tissue.

The present invention is intended to provide a novel suture anchorassembly which may be used to secure soft tissue to bone withoutrequiring the surgeon to tie a knot (or knots) in the suture, and whilepermitting the surgeon to control the tension with which the soft tissueis secured to bone.

SUMMARY OF THE INVENTION

The present invention provides a novel suture anchor assembly which maybe used to secure soft tissue to bone without requiring the surgeon totie a knot (or knots) in the suture, and while permitting the surgeon tocontrol the tension with which the soft tissue is secured to bone.

The present invention generally comprises a suture anchor assemblycomprising a suture anchor body and a suture slidably secured to thesuture anchor body. The suture anchor body is configured to be disposedwithin the bone, and the suture is configured to be passed through oraround the soft tissue which is to be secured to the bone. The sutureanchor body and the suture are configured for knotlessly binding thesuture, whereby to secure the soft tissue to the host bone. Inaccordance with the present invention, knotless suture binding isachieved by pulling successively increasing volumes of suture into atapered binding zone having a successively decreasing cross-sectionalarea so that the sliding suture is eventually jammed, and hence bound,in position.

In accordance with the present invention, the tapered binding zone canbe provided (i) external to the suture anchor body, by the creation of atapered gap between the suture anchor body and the host bone, and/or(ii) internal to the suture anchor body, by providing a tapered bindingzone within the suture anchor body itself.

In one form of the present invention, there is provided apparatus forsecuring an object to bone, the apparatus comprising:

a suture anchor assembly comprising a suture anchor body and a suture;

-   -   the suture anchor body being configured to be lockingly disposed        within a hole formed in the bone, and having an opening formed        therein for slidably receiving the suture therethrough;    -   the suture having a first end, a second end and an intermediate        portion extending therebetween;    -   the suture extending through the opening in the suture anchor        body so that the intermediate portion forms a loop on one side        of the opening and the first and second ends are disposed on the        other side of the opening, such that when the first end of the        suture is passed through the loop and securingly engages the        object, pulling on the second end of the suture draws the loop        and a captured portion of the suture along a path toward the        opening in the suture anchor body;    -   the suture anchor body being configured so that when the suture        anchor body is disposed in the hole in the bone, a tapered        binding zone is established along the path followed by the loop        and the captured portion of the suture when the second end of        the suture is pulled, the tapered binding zone having a        successively decreasing cross-sectional area such that continued        pulling of the second end of the suture causes the loop and the        captured portion of the suture to be jammed tightly in the        tapered binding zone, whereby to bind the suture, and hence the        object, to the suture anchor body, which is itself lockingly        disposed within the bone.

In another form of the present invention, there is provided a method forsecuring an object to bone, the method comprising:

providing an apparatus comprising:

-   -   a suture anchor assembly comprising a suture anchor body and a        suture;        -   the suture anchor body having an opening formed therein for            slidably receiving the suture therethrough;        -   the suture having a first end, a second end and an            intermediate portion extending therebetween;        -   the suture extending through the opening in the suture            anchor body so that the intermediate portion forms a loop on            one side of the opening and the first and second ends are            disposed on the other side of the opening;        -   the suture anchor body being configured so that when the            suture anchor body is disposed in the hole in the bone, a            tapered binding zone is established, the tapered binding            zone having a successively decreasing cross-sectional area;

lockingly positioning the suture anchor body within the hole formed inthe bone;

passing the first end of the suture through the loop and securinglyengaging the object;

pulling on the second end of the suture so as to draw the loop and acaptured portion of the suture into the tapered binding zone so as tocause the loop and the captured portion of the suture to be jammedtightly in the tapered binding zone, whereby to bind the suture, andhence the object, to the suture anchor body, which is itself lockinglydisposed within the bone.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other objects and features of the present invention will bemore fully disclosed or rendered obvious by the following detaileddescription of the preferred embodiments of the invention, which is tobe considered together with the accompanying drawings wherein likenumbers refer to like parts, and further wherein:

FIGS. 1-11 are schematic views showing a first suture anchor assemblyformed in accordance with the present invention;

FIGS. 11A-11D are schematic views showing how additional mass and bulkmay be added to a portion of the suture in order to enhance locking ofthe suture;

FIGS. 12-14 are schematic views showing a second suture anchor assemblyformed in accordance with the present invention;

FIGS. 15-17 are schematic views showing a third suture anchor assemblyformed in accordance with the present invention;

FIGS. 18-20 are schematic views showing a fourth suture anchor assemblyformed in accordance with the present invention;

FIGS. 21-23 are schematic views showing a fifth suture anchor assemblyformed in accordance with the present invention;

FIG. 24 is a schematic view showing a sixth suture anchor assemblyformed in accordance with the present invention;

FIG. 25 is a schematic view showing a seventh suture anchor assemblyformed in accordance with the present invention;

FIGS. 26-29 and 29A are schematic views showing an eighth suture anchorassembly formed in accordance with the present invention;

FIGS. 30-32 are schematic views showing a ninth suture anchor assemblyformed in accordance with the present invention;

FIGS. 33 and 34 are schematic views showing a tenth suture anchorassembly formed in accordance with the present invention;

FIGS. 35 and 36 are schematic views showing an eleventh suture anchorassembly formed in accordance with the present invention; and

FIGS. 37-43 are schematic views showing a twelfth suture anchor assemblyformed in accordance with the present invention.

DETAILED DESCRIPTION OF THE INVENTION

Looking first at FIGS. 1-5, there is shown a novel suture anchorassembly 5 which generally comprises a suture anchor body 10 and asuture 15. Suture anchor assembly 5 may be used to secure soft tissue tobone without requiring the surgeon to tie a knot (or knots) in thesuture, and while permitting the surgeon to control the tension withwhich the soft tissue is secured to bone.

More particularly, suture anchor body 10 comprises a generallycylindrical structure having a distal end 20 and a proximal end 25. Theside wall of suture anchor body 10 is provided with a pair oflongitudinally-extending, diametrically-opposed recesses 30, 35.

Recess 35 preferably increases in depth as it approaches the proximalend of suture anchor body 10, and shallows in depth as it approaches thedistal end of suture anchor body 10. With the disclosed lockingmechanism, for the suture to be locked within the anchor, multiplestrands of suture are pulled into an area smaller than the grouping ofsutures, thereby causing knotless binding. In one preferred form of theinvention, recess 35 has a depth adjacent to the proximal end of sutureanchor body 10 which is greater than the thickness of the grouping ofsuture strands 15, and a depth adjacent to the distal end of sutureanchor body 10 which is less than the thickness of the grouping ofsuture strands 15. In FIGS. 1-5, recess 35 is shown having a somewhatsemi-circular cross-sectional shape, providing tapering in both thelongitudinal (i.e., distal to proximal) direction and the lateraldirection. In other words, a semi-circular recess 35 provides taperingat both the central portion 35A of recess 35 as well as at the edges 35Bof recess 35. However, it should also be appreciated that recess 35 maybe formed as a simple inclined flat plane, such that there is taperingin the longitudinal direction but not in the lateral direction.Furthermore, recess 35 may comprise a combination of differentcross-sections along its length.

One variation to specifically note is providing recess 35 with orwithout a constant floor depth along the length of the recess, but withlateral walls tapering inwardly towards one another as they extenddistally, thereby removing the need to lock suture 15 and loop L betweenbone B and suture body anchor 10, but using those surfaces as merelyboundaries. See FIG. 5A.

It is also contemplated that variations of side-walled tapering/recessfloor tapering may be utilized to effect suture binding.

Another variation for the system's tapering portion may include recess35 having a constant floor depth for a portion of the recess, with atapering floor portion (i.e., an inclined floor) for the remainder ofrecess 35. By using a combination of tapering sections and non-taperingsections, various cinching/binding areas can be achieved.

Recess 30 preferably extends parallel to the central axis of the body,i.e., it has a constant depth along the length of the recess. Recess 30preferably also has a somewhat semi-circular cross-sectional shape,although it may also be formed as a simple flat plane.

A crossbore 40 extends between recesses 30, 35. Crossbore 40 is sized soas to slidingly receive suture 15 as will hereinafter be discussed infurther detail.

The proximal end of suture anchor body 10 includes an opening 45 forreceiving an inserter tool which may be used to deploy suture anchorassembly 5 in bone. Opening 45 is preferably shaped so as to minimizethe amount of material removed from the central portion of the sutureanchor body, which is where the deepest portion of recess 35 is located.Thus, to this end, where recess 35 and recess 30 have semi-circularcross-sections, opening 45 may be formed with an “hour-glass” (or“figure eight”) cross-section. Additionally, by positioning the largestportions of opening 45 at the periphery of the suture anchor body, theinserter may be provided with matching lobes for driving the sutureanchor assembly into bone. This construction can be advantageous, sincemating the inserter and the suture anchor body more laterally (i.e.,further outboard from the central longitudinal axis of the suture anchorbody) provides a longer lever arm which permits more torque to beapplied to the portion of the suture anchor body where more material ispresent.

Furthermore, by positioning crossbore 40 and opening 45 remote from oneanother (i.e., by positioning crossbore 40 at the distal end of theanchor body and positioning opening 45 at the proximal end of the anchorbody), more material is available on the proximal end of the anchor bodyto support the anchor body/inserter interface. Separating the twofeatures (i.e., crossbore 40 and opening 45) also provides more materialto resist pullout of the suture through the anchor body.

If desired, the distal end of suture anchor body 10 may be tapered,e.g., as shown at 50, so as to facilitate insertion of the suture anchorassembly into bone.

Suture 15 comprises a single strand of suture having a leading end (alsoknown as a “pass-thru end”) 55, a trailing end (also know as a“tightening end”) 60 and an intermediate portion 65 extendingtherebetween.

Looking next at FIGS. 6-11, suture anchor assembly 5 may be used in thefollowing manner to secure soft tissue to bone without requiring thesurgeon to tie a knot (or knots) in the suture.

More particularly, leading end 55 of suture 15 is first placed adjacentto trailing end 60 of suture 15, thereby forming a loop L in theintermediate portion 65 of suture 15. Then, loop L is threaded throughcrossbore 40, so that leading end 55 and trailing end 60 are disposed inrecess 30 on one side of suture anchor body 10 and loop L is disposed inrecess 35 on the other side of suture anchor body 10. See FIG. 6.

In an alternative embodiment, another transverse hole (not shown) moreproximal to transverse hole 40 could be provided in suture anchor body10, such that one or both of leads 55 and/or 60 could be directed backto the loop L side of the suture anchor body, i.e., so that one or bothof leads 55 and/or 60 could be directed back into recess 35 and broughtadjacent to loop L. This approach may be used to consolidate theleads/loop adjacent to one another, or to help increase identificationfor which leads 55, 65 control which function. It should be understoodthat this feature may also be adapted to other forms of the presentinvention (see below) where loop L and leads 55, 60 are on opposingsides of the suture anchor.

Then suture anchor assembly 5 is deployed in a bone B, preferably byadvancing the distal end of suture anchor assembly 5 into a bone hole Hformed in bone B. See FIG. 7. This may be done by mounting the distalend of an inserter I (FIG. 2) in opening 45 in suture anchor body 10,and simultaneously pulling a slight tension on (i) loop L and (ii)leading end 55 and trailing end 60, so that suture 15 is seated inrecesses 30, 35. Then the inserter is used to push suture anchorassembly 5 into bone hole H.

It will be appreciated that inasmuch as the depth of recess 35 decreasesadjacent to the distal end of suture anchor body 10, the gap between thefloor of recess 35 and the wall of bone hole H (i.e., the space forreceiving suture 15) progressively narrows towards the distal end ofsuture anchor body 10. In an alternative embodiment, recess 35 could beformed so that it extends substantially parallel to the axis of sutureanchor body 10, but bone hole H might be tapered (see FIG. 7A). Ineither case, it will be appreciated that the space between the floor ofrecess 35 and the wall of bone hole H progressively narrows towards thedistal end of suture anchor body 10.

Next, leading end 55 is passed over (or through) tissue T and thenthrough loop L. See FIG. 8.

Then, with leading end 55 held under tension, trailing end 60 is pulled.This action causes loop L and a portion 65A of the suture trailingleading end 55 to be drawn progressively deeper into bone hole H, andhence progressively deeper into the narrowing gap formed between sutureanchor body 10 and bone B. See FIGS. 9-11. Thus, the more that trailingend 60 is pulled, the farther that loop L and suture portion 65A ispulled into the narrowing gap between suture anchor body 10 and bone B.Further pulling of trailing end 60 effectively jams loop L and sutureportion 65A between suture anchor body 10 and bone B, thereby bindingthe suture at this location. This action effectively results in a fixedlength 70 of suture 15 extending from loop L, over (or through) tissueT, and then back to loop L, with loop L being locked in positionrelative to the bone. Thus, by holding leading end 55 of suture 15 undertension and pulling trailing end 60 of suture 15 until loop L is lockedin position between suture anchor body 10 and bone B, tissue T can besecured to bone B without requiring the surgeon to tie a knot (or knots)in the suture.

Stated differently, suture 15 is secured to bone B by pulling loop L andsuture portion 65A into the narrowing gap formed between suture anchorbody 10 and bone B until the suture is effectively jammed in place,thereby forming a knotless fixation.

It should be appreciated that it may be possible to improve the bindingof suture 15 to bone B by adding mass and bulk to the portion of thesuture which is drawn down into the narrowing gap formed between sutureanchor body 10 and bone B. See, for example, FIGS. 11A, 11B, 11C and11D. In these examples, additional mass and bulk is added to a portionof suture loop L. This additional mass and bulk helps the suture to morerepeatably and controllably lock into the narrowing taper formed betweensuture anchor body 10 and bone B. In FIG. 11A, the additional mass andbulk is added by simply pre-knotting (e.g., at the time of manufacture)suture 15 at loop L. In FIG. 11B, the suture diameter is made thicker byovermolding, weaving or the addition of extra material to the suture,with the particular technique used depending the nature of the suturematerial and manufacturing preference. Thus, for example, where thesuture is braided suture, the additional material may be deposited byovermolding on the braided suture or by additional weaving.Alternatively, where the suture is extruded monofilament, the additionalmaterial may be deposited by overmolding. In FIG. 11C, a bead ofmaterial is secured to suture loop L so that the bead of materialincreases the mass and bulk of the suture. Again, the specific manner inwhich this is done may depend on suture material and manufacturingpreference. Thus, where the suture is braided suture, the bead ofmaterial may be strung onto the braided suture and then fixed in place(e.g., by an adhesive). Alternatively, where the suture is monofilamentsuture, the bead of material may be secured to the suture byovermolding. In FIG. 11D, a bead of a specific geometry (e.g.,non-circular, triangular, rectangular, etc.) is attached to suture loopL. If desired, the specific geometry may be sized and shaped to fit intoa specific recess formed within suture anchor body 10 so as to improvesuture locking. All of these, and other, approaches add mass and bulk tothe suture which aides cinching and securement. It is understood thatthe bulking features could be rigidly attached to the suture, or thebulking features may merely surround the suture and be free to slidethereon. In this latter respect, it will be appreciated that threadingthe suture ends through crossbore 40 would effectively capture the freefloating bulking feature onto loop L.

Additionally, it should be appreciated that all of these sutureadditions are described as being attached at suture loop L rather thanon pass-thru end 55. These features may be on either, though it is moredesirable to include them on the loop L portion since these sutureadditions do not interfere with passing pass-thru end 55 through tissue(e.g., if the suture additions were placed on pass-thru end 55, a largerhole would have to be made in the tissue to pass the suture, suturepassage might be hindered, etc.). By increasing the bulk of suture loopL, the cinching and securement of the suture may be enhanced and moreprecisely controlled.

Looking next at FIGS. 12-14, there is shown a novel suture anchorassembly 75 also formed in accordance with the present invention. Sutureanchor assembly 75 is substantially the same as suture anchor assembly 5discussed above, and is used in substantially the same way, except that(i) crossbore 40 is formed with a narrow throat 40A and flares outwardlyat 40B as it approaches recess 35, and (ii) recesses 30 and 35 areformed with a floor which extends generally parallel to the central axisof suture anchor body 10. By forming crossbore 40 with a narrow throat40A which flares outwardly at 40B as it opens towards recess 35, asuture binding zone is formed at the intersection of crossbore throat40A and crossbore flare 40B. As a result, when tightening end 60 ispulled, loop L and suture portion 65A are pulled down into the bindingzone created at the intersection of crossbore throat 40A and crossboreflare 40B, whereupon they bind, securing the tissue to the bone anchorbody and hence to the bone. By forming recesses 30, 35 with flat (i.e.,non-tapered) floors, suture 15 may be slid more easily into, and out of,crossbore 40, whereby to facilitate binding loop L and suture portion65A at the convergence of crossbore throat 40A and crossbore flare 40B.Additionally, corner edgebreaks 40C, located at the transition pointsbetween crossbore 40 and recess 30 and/or recess 35, may be added inorder to reduce the wear of the suture by softening the transitionbetween recesses 30, 35 and crossbore 40.

By establishing the narrowing gap of the suture binding zone of sutureanchor assembly 75 within crossbore 40 (as opposed to establishing thesuture binding zone of suture anchor assembly 5 in the gap betweensuture anchor body 10 and bone B), a significant benefit may beobtained. More particularly, by creating the narrowing gap of the suturebinding zone within crossbore 40, consistent geometries are providedwhich ensure binding of the suture with the anchor. In contrast, theexternal locking (between the anchor body and bone) of suture anchorassembly 5 relies on bone B and bone hole H to be substantiallyconsistent for each use, even though they are potentially variable innature due to variations in bone quality, patient anatomy, disease,trauma, and the surgical technique used to prepare the bone hole. Byproviding the suture binding zone in a narrowing crossbore 40, it isalso possible to eliminate the need to carefully size bone hole Hrelative to suture anchor body 10 in order to ensure proper suturesecurement.

An additional benefit of binding the suture within crossbore 40, ratherthan adjacent to the sidewall of suture anchor body, is that the sutureanchor assembly can better resist loosening of the soft tissue relativeto the bone anchor assembly. This is because the suture binding islocated perpendicular to the axis of withdrawal (i.e., the longitudinalaxis of the bone hole) rather than parallel to the axis of withdrawal.

Furthermore, positioning the binding zone within tapered crossbore 40provides the bound suture with a surrounding support structure ofsubstantial integrity, thereby making the securement more stable andresisting failure of the suture anchor assembly.

Furthermore, if desired, recesses 30 and 35 may be terminated adjacentto crossbore 40, so that the recesses do not run the full length of thesuture anchor body. This construction can help protect the suture duringsuture anchor insertion, and can provide additional strength at thedistal end of the suture anchor body.

Looking next at FIGS. 15-17, there is shown a novel suture anchorassembly 80 also formed in accordance with the present invention. Sutureanchor assembly 80 is substantially the same as suture anchor assembly75 discussed above, and is used in substantially the same way, exceptthat crossbore 40 has a sweeping taper along its length, whereby toprovide a gently narrowing gap of the suture binding zone. Again, thisconstruction can provide a more suture-friendly configuration whilestill permitting operation of the present invention.

Looking next at FIGS. 18-20, there is shown a novel suture anchorassembly 85 also formed in accordance with the present invention. Sutureanchor assembly 85 is substantially the same as suture anchor assembly 5discussed above, and is used in substantially the same way, except thatrecess 35 includes a plurality of ribs 90. Ribs 90 help resist proximalmovement of loop L and suture portion 65A relative to suture anchor body10, while not resisting distal movement of loop L and suture portion 65Arelative to suture anchor body 10.

In addition, as shown in FIGS. 18-20, a rounded corner 25A may beprovided at the transition point between the proximal surface of thesuture anchor body and recess 35 (and also recess 30, if desired) so asto soften the transition out of recess 35 (and also recess 30, ifdesired) and thereby reduce wear and abrasion of suture 15.

Looking next at FIGS. 21-23, there is shown a novel suture anchorassembly 95 also formed in accordance with the present invention. Sutureanchor assembly 95 is substantially the same as suture anchor assembly 5discussed above, and is used in substantially the same way, except thatsuture anchor body 10 comprises a plurality of surface ridges 100.Surface ridges 100 help resist proximal movement of suture anchor body10 relative to the bone, while not resisting distal movement of sutureanchor body 10 into bone hole H. In this specific embodiment, ridges 100are formed by intersecting clockwise and counter-clockwise helical cuts.The resolution of the ridges, the ridge root width, and angle ofincidence between the ridges is controlled by the pitch on the helicalcuts and the number of leads. In the case where finer engagement withbone is required, a finer pitch can be used; in the case where coarserengagement with bone is required, coarser pitches may be used toincrease engagement with the bone. To increase or decrease root width,less or more leads can be used to increase or decrease the distancebetween two adjacent cuts, accordingly.

The geometry of the cuts is important for enhancing bone engagement. Asshown in FIGS. 21-23, the cuts are preferably substantiallyperpendicular to the body of the suture anchor on the proximal side ofthe ridges but are substantially tapered on the distal portion of theridges. The perpendicular proximal side enhances gripping of the bonewhile the tapered distal portion facilitates slipping the device pastthe bone for ease of insertion into bone hole H. The geometry of thehelical sweeps can be varied so as to increase grip on the bone or toease insertion through the bone, for instance by making the proximalside of the ridge undercut relative to a perpendicular cut as shown.

Looking next at FIG. 24, there is shown a novel suture anchor assembly105 also formed in accordance with the present invention. Suture anchorassembly 105 is substantially the same as suture anchor assembly 95discussed above, and is used in substantially the same way, except thatribs 90 are provided in recess 35.

Looking next at FIG. 25, there is shown a novel suture anchor assembly110 also formed in accordance with the present invention. Suture anchorassembly 110 is substantially the same as suture anchor assembly 105discussed above, and is used in substantially the same way, except thatit provides a rounded distal tip 115 to suture anchor body 10. Thisconstruction provides suture anchor body 10 with a distal tip whichfacilitates insertion into the bone hole. Of course, it is also possibleto provide many other distal end geometries of the sort well known inthe art to aid in the insertion of the suture anchor body into bone,e.g., such as breaking the distal end, providing a generously roundedlead-in or tapered portion, or providing any other feature thatincorporates a reduced cross-section tip for more easily locating theanchor in the prepared hole.

Looking next at FIGS. 26-29 and FIG. 29A, there is shown a novel sutureanchor assembly 120 also formed in accordance with the presentinvention. Suture anchor assembly 120 generally comprises a sutureanchor body 125 and a suture 15. Suture anchor assembly 120 may be usedto secure soft tissue to bone without requiring the surgeon to tie aknot (or knots) in the suture.

More particularly, suture anchor body 125 comprises a generallycylindrical structure having a distal end 130 and a proximal end 135. Atapered lumen 140 extends from distal end 130 to proximal end 135. Moreparticularly, lumen 140 tapers inwardly as it extends distally alongsuture anchor body 125. Thus, and as will hereinafter be discussed infurther detail, the gap between the opposing walls of tapered lumen 140progressively narrows towards the distal end of suture anchor body 125.Preferably a side opening 145 is formed in suture anchor body 125 nearthe proximal end of the anchor body, and/or a side opening 150 is formedin suture anchor body 125 near the distal end of the anchor body.

It should be appreciated that the tapered portion of tapered lumen 140may extend the entire length of tapered lumen 140 or along only aportion (or portions) of tapered lumen 140. Thus, for example, thetapered portion of tapered lumen 140 may be disposed between twocylindrical sections, or it may be located distal of a proximalcylindrical section, or it may be located proximal of a distalcylindrical section. Additionally, tapered lumen 140 could comprise astep-like combination of tapered and cylindrical portions (i.e., likestairs). These configurations can help improve sliding of suture 15within tapered lumen 140 and to help ensure that the locking portion ofthe suture will come to rest adjacent to a specific section of thesuture anchor body (e.g., a portion of the suture anchor body having amore substantial cross-section so as to provide increased body strength,or an area with internal features for interlocking with the suture,etc.).

As previously described, suture 15 comprises a single strand of suturehaving a leading end 55, a trailing end 60 and an intermediate portion65 therebetween.

Suture anchor assembly 120 may be used as follows to secure soft tissueto bone without requiring the surgeon to tie a knot (or knots) in thesuture.

More particularly, leading end 55 of suture 15 is first placed adjacentto trailing end 60 of suture 15, thereby forming a loop L in theintermediate portion 65 of suture 15. Then, leading end 55 and trailingend 60 are threaded down tapered lumen 140, out the distal end oftapered lumen 140, up the exterior of suture anchor body 125, into sideopening 145, back into tapered lumen 140 and then out the proximal endof suture anchor body 125. See FIG. 26. If desired, a trough or groovemay be provided on the exterior surface of suture anchor body 125 toreceive the suture between openings 140 and 145. This can help protectthe suture from wear and abrasion from the surrounding bone duringinsertion and/or during sliding of the suture (e.g., during securementand/or adjustment).

Then suture anchor assembly 120 is deployed in a bone, preferably byadvancing distal end 130 of suture anchor body 125 into a hole formed inthe bone. This may be done by mounting the distal end of an inserter I(FIG. 29A) into tapered lumen 140 of suture anchor body 125,simultaneously pulling a slight tension on (i) loop L and (ii) leadingend 55 and trailing end 60, so that suture 15 is drawn taut around thedistal end of suture anchor body 125. Then the inserter is used to pushsuture anchor assembly 120 into the bone hole.

Next, leading end 55 is passed over (or through) tissue and then throughloop L.

Then, with leading end 55 held under tension, trailing end 60 is pulled.This action causes loop L and intermediate portion 65 of suture 15 to bedrawn into, and then progressively deeper into, tapered lumen 140.However, as indicated above, the gap between the opposing walls oftapered lumen 140 (i.e., the space for receiving suture 15)progressively narrows along the length of suture anchor body 125. Thus,the more that trailing end 60 of suture 15 is pulled, the farther thatloop L and suture mid-section 65 is pulled into the narrowing gapbetween the opposing side walls of tapered lumen 140. Pulling oftrailing end 60 continues until loop L and suture mid-section 65 areeffectively jammed between the opposing side walls of tapered lumen 140,thereby binding the suture at this location. This action effectivelyresults in a fixed length of suture 15 extending from loop L, over (orthrough) the tissue, and then back to loop L, with loop L being lockedin position relative to the anchor body and hence to the bone. Thus, byholding leading end 55 under tension and pulling trailing end 60 untilloop L and the suture mid-section 65 are locked, the tissue can besecured to the bone without requiring the surgeon to tie a knot (orknots) in the suture.

If desired, suture 15 can be passed through side opening 150 instead ofside opening 145. However, passing the suture external to the anchorthrough the more proximal opening 145 (rather than the more distalopening 150) can provide a variety of benefits, including providingadditional bulk to the anchor body leading to improved anchoring to boneand smoother flow of the sutures. On the other hand, passing the suturesthrough the more distal opening 150 (rather than the more proximalopening 145) can help limit the exposure of the suture to the bone,thereby reducing potential damage to the suture.

It may also be beneficial to place the suture pass-thru hole (e.g., sideopenings 145, 150, etc.) on other locations in the anchor body so as tobetter protect the suture, better secure the anchor to the bone, improvethe suture securement, etc.

Looking next at FIGS. 30-32, there is shown a novel suture anchorassembly 155 also formed in accordance with the present invention.Suture anchor assembly 155 is substantially the same as suture anchorassembly 120 discussed above, except that (i) side openings 145, 150 areformed substantially diametrically-opposed from one another, and (ii)tapered lumen 140 is formed with internal ribs 160. Furthermore suture15 is threaded into suture anchor body 125 by threading leading end 55and trailing end 60 down tapered lumen 140, out the distal end oftapered lumen 140, then leading end 55 is brought up the exterior ofsuture anchor body 125, in side opening 150, back into tapered lumen 140and then out the proximal end of suture anchor body 125. Trailing end 60is brought up the exterior of suture anchor body 125, in side opening145, back into tapered lumen 140, and then out the proximal end ofsuture anchor body 125.

Suture anchor assembly 155 is used in substantially the same way assuture anchor assembly 120, i.e., after the suture anchor body isdisposed in the bone, leading end 55 of suture 15 is passed over (orthrough) the tissue to be captured, through loop L and then, whileleading end 55 is held under tension, trailing end 60 is pulled so as todraw loop L and a new portion of the suture mid-section 65 down taperedlumen 140 until loop L and suture mid-section 65 are locked in position.In this way, suture anchor assembly 155 can be used to secure tissue tobone without requiring the surgeon to tie a knot (or knots) in thesuture. Also, as suture 15 is tensioned, it could pull inward tabs 163that extend distal to holes 145 and 150 in suture anchor body 125,further locking suture 15 within tapered lumen 140 of the device.

Looking next at FIGS. 33 and 34, there is shown a novel suture anchorassembly 165 also formed in accordance with the present invention.Suture anchor assembly 165 is substantially the same as suture anchorassembly 120 discussed above, except that (i) side openings 145, 150 areomitted, (ii) a crosspin 170 is formed at the distal end of taperedlumen 140, and (iii) ribs 175 are formed on the exterior of sutureanchor body 125. Furthermore, suture 15 is threaded into suture anchorbody 125 by threading leading end 55 and trailing end 60 down taperedlumen 140, around crosspin 170, then back up tapered lumen 140 and outthe proximal end of suture anchor body 125.

Features such as ribs 175 may be added to exterior surfaces of thesuture anchor body so as to improve the grip of the suture anchor bodyon the bone. Other external features may also be used, e.g., threads,opposing threads, bumps, textures, ridges, discontinuous features, etc.

Suture anchor assembly 165 is used in substantially the same way assuture anchor assembly 120, i.e., after the suture anchor body isdisposed in the bone, leading end 55 of suture 15 is passed over (orthrough) the tissue to be captured, through loop L and then, whileleading end 55 is held under tension, trailing end 60 is pulled so as todraw loop L and suture mid-section 65 down tapered lumen 140 until loopL and suture mid-section 65 are locked in position. In this way, sutureanchor assembly 155 can be used to secure tissue to bone withoutrequiring the surgeon to tie a knot (or knots) in the suture.

Looking next at FIGS. 35 and 36, there is shown a novel suture anchorassembly 180 also formed in accordance with the present invention.Suture anchor assembly 180 is substantially the same as suture anchorassembly 165 discussed above, except that tapered lumen 140 is a blindhole terminating proximal to the distal end of suture anchor body 125 soas to provide a distal end wall 185, and at least two openings 190, 195are formed through the distal end wall. Furthermore, suture 15 isthreaded into suture anchor body 125 by threading leading end 55 andtrailing end 60 down tapered lumen 140, out of an opening (e.g., opening195), along the exterior of the distal end wall, into an opening (e.g.,opening 190), and then back up tapered lumen 140 and out the proximalend of suture anchor body 125. A trough or groove to connect openings195 and 190 may be provided so as to protect the suture, especiallyduring insertion into bone.

Suture anchor assembly 180 is used in substantially the same way assuture anchor assembly 165, i.e., after the suture anchor body isdisposed in the bone, leading end 55 of suture 15 is passed over (orthrough) the tissue to be captured, through loop L and then, whileleading end 55 is held under tension, trailing end 60 is pulled so as todraw loop L and suture mid-section 65 down tapered lumen 140 until loopL and suture mid-section 65 are locked in position. In this way, sutureanchor assembly 155 can be used to secure tissue to bone withoutrequiring the surgeon to tie a knot (or knots) in the suture.

Looking next at FIGS. 37-43, there is shown a novel suture anchorassembly 200 also formed in accordance with the present invention.Suture anchor assembly 200 is substantially the same as suture anchorassembly 185 discussed above, except that four openings are formedthrough the distal end wall, the suture follows a slightly differentpath, and the exterior of suture anchor body 125 may be formed withoutribs. However, it should be understood that with suture anchor assembly200 (and also with suture anchor assembly 180, etc.) there are amultitude of external features that may or may not be included for thepurpose of enhancing fixation of the anchor body to bone. For example,the opposing helical cuts (such as shown in suture anchor assembly 95)are such a feature. Ribs, bumps and other texturing features may also beincluded. Suture anchor assembly 200 generally comprises a suture anchorbody 125 and a suture 15. Suture anchor assembly 200 may be used tosecure soft tissue to bone without requiring the formation of a knot (orknots).

Suture anchor body 125 comprises a generally tapered structure having adistal end 130 and a proximal end 135. A tapered lumen 140 extends fromdistal end 130 to proximal end 135. More particularly, tapered lumen 140tapers inwardly as it extends distally along suture anchor body 125.Thus, and as will hereinafter be discussed in further detail, the gapbetween the opposing walls of tapered lumen 140 progressively narrowstowards the distal end of suture anchor body 125. Preferably fouropenings 205, 210, 215, 220 are formed in the distal end wall of sutureanchor body 125.

Suture 15 comprises a single strand of suture having a leading end 55, atrailing end 60 and an intermediate portion 65 therebetween.

More particularly, leading end 55 of suture 15 is first placed adjacentto trailing end 60 of suture 15, thereby forming a loop L inintermediate portion 65 of suture 15. Then, leading end 55 is passeddown tapered lumen 140, out of opening 205, across the exterior of thedistal end wall, into opening 210, back up tapered lumen 140 and thenout the proximal end of suture anchor body 125. Then, trailing end 60 ispassed down tapered lumen 140, out of opening 215, across the exteriorof the distal end wall, into opening 220, back up tapered lumen 140 andthen out the proximal end of suture anchor body 125. See FIG. 38.

Then suture anchor assembly 200 is deployed in a bone, preferably byadvancing distal end 130 of suture anchor assembly 200 into a holeformed in the bone. This may be done by mounting the distal end of aninserter (not shown) into tapered lumen 140 of suture anchor body 125,pulling a slight tension on loop L, and leading end 55 and trailing end60, so that suture 15 is drawn taut around the distal end of sutureanchor body 125. Then the inserter is used to push suture anchorassembly 200 into the bone hole. See FIG. 40.

Next, leading end 55 is passed over (or through) tissue T (see FIG. 41)and then through loop L (see FIG. 42).

Then, with leading end 55 held under tension, trailing end 60 is pulled.This action causes loop L and intermediate portion 65 to be drawn into,and then progressively deeper into, tapered lumen 140 which hasprogressively narrowing cross-section. See FIG. 43. The more thattrailing end 60 is pulled, the farther that loop L and suturemid-section 65 are pulled into the narrowing gap between the opposingside walls of tapered lumen 140 eventually jamming all of the suturebetween the opposing side walls of tapered lumen 140, thereby bindingthe suture at this location. This action effectively results in a fixedlength of suture 15 extending from loop L, over (or through) tissue T,and then back to loop L, with loop L being locked in position relativeto the anchor body and hence the bone. Thus, by holding leading end 55under tension and pulling trailing end 60 until loop L and suturemid-section 65 are locked, tissue T can be secured to the bone withoutrequiring the surgeon to tie a knot (or knots) in the suture.

Thus it will be seen that the present invention provides a novel sutureanchor which may be used to secure soft tissue to bone without requiringthe surgeon to tie a knot (or knots) in the suture.

Clinical Applications

In the foregoing discussion, the present invention is discussed in thegeneral context of being used to secure soft tissue to bone.

In preferred clinical applications, the present invention may be used tosecure a ligament to bone, a tendon to bone, a labrum to the acetabulum,etc. In essence, the present invention may be used to securesubstantially any soft tissue to any bone.

It should also be appreciated that the present invention may be used tosecure objects other than soft tissue to bone. By way of example but notlimitation, the present invention may be used to secure an implant tobone.

Thus it will be seen that the present invention may be used to securesubstantially any object to substantially any bone.

Modifications of the Preferred Embodiments

It should be understood that many additional changes in the details,materials, steps and arrangements of parts, which have been hereindescribed and illustrated in order to explain the nature of the presentinvention, may be made by those skilled in the art while still remainingwithin the principles and scope of the invention.

1. Apparatus for securing an object to bone, the apparatus comprising: asuture anchor assembly comprising a suture anchor body and a suture; thesuture anchor body being configured to be lockingly disposed within ahole formed in the bone, and having an opening formed therein forslidably receiving the suture therethrough; the suture having a firstend, a second end and an intermediate portion extending therebetween;the suture extending through the opening in the suture anchor body sothat the intermediate portion forms a loop on one side of the openingand the first and second ends are disposed on the other side of theopening, such that when the first end of the suture is passed throughthe loop and securingly engages the object, pulling on the second end ofthe suture draws the loop and a captured portion of the suture along apath toward the opening in the suture anchor body; the suture anchorbody being configured so that when the suture anchor body is disposed inthe hole in the bone, a tapered binding zone is established along thepath followed by the loop and the captured portion of the suture whenthe second end of the suture is pulled, the tapered binding zone havinga successively decreasing cross-sectional area such that continuedpulling of the second end of the suture causes the loop and the capturedportion of the suture to be jammed tightly in the tapered binding zone,whereby to bind the suture, and hence the object, to the suture anchorbody, which is itself lockingly disposed within the bone.
 2. Apparatusaccording to claim 1 wherein the tapered binding zone is establishedbetween the suture anchor body and the side wall of the hole in thebone.
 3. Apparatus according to claim 2 wherein the suture anchor bodyis tapered relative to the side wall of the hole in the bone. 4.Apparatus according to claim 3 wherein the suture anchor body comprisesa groove, and further wherein the floor of the groove is inclinedrelative to the side wall of the hole in the bone.
 5. Apparatusaccording to claim 4 wherein the floor of the groove comprises surfacestructures to help bind the loop and the captured portion of the suturewithin the tapered binding zone.
 6. Apparatus according to claim 5wherein the surface structures comprise ribs.
 7. Apparatus according toclaim 1 wherein the tapered binding zone is established between surfacesof the suture anchor body.
 8. Apparatus according to claim 7 wherein thetapered binding zone is established within the opening in the sutureanchor body.
 9. Apparatus according to claim 8 wherein the opening istapered.
 10. Apparatus according to claim 8 wherein the suture anchorbody comprises a distal end, a proximal end and a longitudinal axisextending between the distal end and the proximal end, and furtherwherein the opening extends transverse to the longitudinal axis of thesuture anchor body.
 11. Apparatus according to claim 8 wherein thesuture anchor body comprises a distal end, a proximal end and alongitudinal axis extending between the distal end and the proximal end,and further wherein the opening extends substantially parallel to thelongitudinal axis of the suture anchor body.
 12. Apparatus according toclaim 7 wherein the tapered binding zone is disposed adjacent to theopening in the suture anchor body.
 13. Apparatus according to claim 12wherein the opening is formed by a pin extending across the taperedbinding zone.
 14. Apparatus according to claim 12 wherein the opening isformed by a hole in a wall extending across the tapered binding zone.15. Apparatus according to claim 1 wherein the suture anchor bodycomprises surface structures to help lock the suture anchor body withinthe hole formed in the bone.
 16. Apparatus according to claim 15 whereinthe surface structures comprise ribs.
 17. Apparatus according to claim15 wherein the surface structures comprise helical cuts formed in theouter surface of the suture anchor body.
 18. Apparatus according toclaim 2 wherein the side wall of the hole in the bone is taperedrelative to the suture anchor body.
 19. Apparatus according to claim 1wherein the suture comprises an additional mass along its intermediateportion.
 20. Apparatus according to claim 19 wherein the additional masscomprises a knot.
 21. Apparatus according to claim 19 wherein theadditional mass comprises a thickened section of suture.
 22. Apparatusaccording to claim 19 wherein the additional mass comprises a bead ofmaterial carried on the suture.
 23. Apparatus according to claim 1wherein the object comprises soft tissue.
 24. Apparatus according toclaim 23 wherein the soft tissue comprises at least one from the groupconsisting of a ligament, a tendon and a labrum.
 25. Apparatus accordingto claim 1 wherein the apparatus further comprises an inserter forpositioning the suture anchor assembly in the hole in the bone.
 26. Amethod for securing an object to bone, the method comprising: providingan apparatus comprising: a suture anchor assembly comprising a sutureanchor body and a suture; the suture anchor body having an openingformed therein for slidably receiving the suture therethrough; thesuture having a first end, a second end and an intermediate portionextending therebetween; the suture extending through the opening in thesuture anchor body so that the intermediate portion forms a loop on oneside of the opening and the first and second ends are disposed on theother side of the opening; the suture anchor body being configured sothat when the suture anchor body is disposed in the hole in the bone, atapered binding zone is established, the tapered binding zone having asuccessively decreasing cross-sectional area; lockingly positioning thesuture anchor body within the hole formed in the bone; passing the firstend of the suture through the loop and securingly engaging the object;pulling on the second end of the suture so as to draw the loop and acaptured portion of the suture into the tapered binding zone so as tocause the loop and the captured portion of the suture to be jammedtightly in the tapered binding zone, whereby to bind the suture, andhence the object, to the suture anchor body, which is itself lockinglydisposed within the bone.
 27. A method according to claim 26 wherein thetapered binding zone is established between the suture anchor body andthe side wall of the hole in the bone.
 28. A method according to claim27 wherein the suture anchor body is tapered relative to the side wallof the hole in the bone.
 29. A method according to claim 28 wherein thesuture anchor body comprises a groove, and further wherein the floor ofthe groove is inclined relative to the side wall of the hole in thebone.
 30. A method according to claim 29 wherein the floor of the groovecomprises surface structures to help bind the loop and the capturedportion of the suture within the tapered binding zone.
 31. A methodaccording to claim 30 wherein the surface structures comprise ribs. 32.A method according to claim 26 wherein the tapered binding zone isestablished between surfaces of the suture anchor body.
 33. A methodaccording to claim 32 wherein the tapered binding zone is establishedwithin the opening in the suture anchor body.
 34. A method according toclaim 33 wherein the opening is tapered.
 35. A method according to claim33 wherein the suture anchor body comprises a distal end, a proximal endand a longitudinal axis extending between the distal end and theproximal end, and further wherein the opening extends transverse to thelongitudinal axis of the suture anchor body.
 36. A method according toclaim 33 wherein the suture anchor body comprises a distal end, aproximal end and a longitudinal axis extending between the distal endand the proximal end, and further wherein the opening extendssubstantially parallel to the longitudinal axis of the suture anchorbody.
 37. A method according to claim 32 wherein the tapered bindingzone is disposed adjacent to the opening in the suture anchor body. 38.A method according to claim 37 wherein the opening is formed by a pinextending across the tapered binding zone.
 39. A method according toclaim 37 wherein the opening is formed by a hole in a wall extendingacross the tapered binding zone.
 40. A method according to claim 26wherein the suture anchor body comprises surface structures to help lockthe suture anchor body within the hole formed in the bone.
 41. A methodaccording to claim 40 wherein the surface structures comprise ribs. 42.A method according to claim 40 wherein the surface structures comprisehelical cuts formed in the outer surface of the suture anchor body. 43.A method according to claim 27 wherein the side wall of the hole in thebone is tapered relative to the suture anchor body.
 44. A methodaccording to claim 26 wherein the suture comprises an additional massalong its intermediate portion.
 45. A method according to claim 44wherein the additional mass comprises a knot.
 46. A method according toclaim 44 wherein the additional mass comprises a thickened section ofsuture.
 47. A method according to claim 44 wherein the additional masscomprises a bead of material carried on the suture.
 48. A methodaccording to claim 26 wherein the object comprises soft tissue.
 49. Amethod according to claim 48 wherein the soft tissue comprises at leastone from the group consisting of a ligament, a tendon and a labrum. 50.A method according to claim 26 wherein the apparatus further comprisesan inserter for positioning the suture anchor assembly in the hole inthe bone.
 51. Apparatus for securing an object to bone, the apparatuscomprising: a suture anchor assembly comprising a suture anchor body anda suture; the suture anchor body being configured to be lockinglydisposed within a hole formed in the bone, and having an opening formedtherein for slidably receiving the suture therethrough; the sutureanchor body comprising a tapered portion in proximity to the opening;the suture having a first end, a second end and an intermediate portionextending therebetween; the suture extending through the opening in thesuture anchor body and in contact with the tapered portion so that theintermediate portion forms a loop on one side of the opening and thefirst and second ends are disposed on the other side of the opening. 52.Apparatus according to claim 51 wherein, when the first end of thesuture is passed through the loop and securingly engages the object,pulling on the second end of the suture draws the loop and a capturedportion of the suture along a path toward the opening in the sutureanchor body.
 53. Apparatus according to claim 52 wherein the sutureanchor body is configured so that when the suture anchor body isdisposed in the hole in the bone, a constricting volume portion isestablished along the path followed by the loop and the captured portionof the suture, so that when the second end of the suture is pulled, theloop and the captured portion of the suture are drawn into theconstricting volume portion, whereby to bind on themselves and lock thesuture in place.
 54. Apparatus according to claim 53 wherein, when thesecond end of the suture is pulled, a successively decreasingcross-sectional area of the constricting volume portion causes the loopand the captured portion of the suture to be jammed tightly in thedecreasing cross-sectional area, whereby to bind the suture, and hencethe object, to the suture anchor body, which is itself lockinglydisposed within the bone.
 55. Apparatus according to claim 53 whereinthe constricting volume portion is established between the suture anchorbody and a portion of the surrounding bone.
 56. Apparatus according toclaim 55 wherein the suture anchor body increases in volume relative tothe surrounding bone.
 57. Apparatus according to claim 56 wherein thesuture anchor body comprises a groove, and further wherein the floor ofthe groove is inclined relative to surrounding bone.